Doctor Name: | WAYNE N LEEVES |
NPI Number: | 1780662643 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | E8657 |
Business Practice Address: | 4002 Technology Ctr Longview, TX - 756052697 |
Business Phone Number: | 9032470484 |
Business Fax Number: | 9032470485 |
Mailing Address: | 323 N Fannin, TYLER |
State: | TX |
Postal Code: | 757027321 |
Phone Number: | 9035319835 |
Fax Number: | |
NPI Enumeration Date: | 01/02/2006 |
NPI Last Update Date: | 05/28/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | E8657 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |